1. Leprosy : Eliminated but not Eradicated
Keep your eye on early signs
When Mahatma Gandhi was invited to inaugurate a leprosy hospital called kasturba
kushta nivaran nilayam building in Tamil Nadu , he replied the invitees as ;
“ Get someone to open it. Opening a hospital is not a big matter, but I shall come to close
it”
He emphasized the need to eliminate leprosy from India. He represented, worked and
spoke behalf of innocent patients of leprosy.
Mahatma Gandhi was trying hard to guide the mind of people towards peace.
“ An eye for eye makes the whole world blind”
This was one of his greatest historical saying, on non violence .
Therefore this great spiritual leader in Asia is commemorated twice a year
internationally. His birthday, 2nd October is commemorated in India as Gandhi Jayanthi,
a national holiday and in the world as the International day of non violence. His date of
death , 30th January is marked as Anti leprosy day throughout the world.
Leprosy was a disease that disturbed the mind of public while affecting the body of
innocent patients. It was ubiquitous hundred years ago but now mostly confined to
tropical and subtropical regions of Africa and Asia. It was considered as one of the most
misunderstood diseases in the past. There were some non scientific belief on the
causation of the disease such as divine curse, heredity and food habits. Some people have
thought that it can be caused by undesirable mixture of foods. One example for that was
eating onion with milk or foul fish. Leprosy was accepted as a deforming, disfiguring,
incurable , highly infectious and fatal disease.
The patients with leprosy, were in compulsory isolation and segregation due to the myths
and misconception of the disease in the past. Some discriminative rules and regulations
were imposed on these patients in many countries. The patients who worked in the
institutions may have to go on long leave of absence from work. Life insurance
corporation of India, did not insure leprosy patients. They were not allowed to contest
elections. The traveling was restricted for them. The divorce was granted under various

2. marriage acts on the ground of leprosy. The separation and later divorce was permitted
through Christian marriage act 1872 and Muslim marriage act 1939. Acquiring driving
license was not allowed according to motor vehicle act 1939 in India. Under the Hindu
succession act 1956, patient could not have a share of the ancestral property and could
not give any property to his heirs because he was considered to have undergone social
death.
Segregation camps were built in many countries to keep away the leprosy patients from
the society in the past. The first leprosy asylum in South East Asia was established at
Hendala, Sri Lanka in 1708. The second leprosy asylum in Sri Lanka was established at
the island, Manthiv within the Batticaloa lagoon. The leprosy patients were admitted to
these hospitals till 1960, compulsorily when identified. Currently, there are about forty
inmates in Hendala hospital though they have been cured with proper treatment. These
elderly inmates have no relationships with their families as they were staying there for
decades.
Leprosy was considered as a contagious disease until the discovery of treatment with
dapsone in late 1930. Sometimes later resistance has been developed by leprosy bacilli to
dapsone. Then the leprosy has been changed into a completely and easily curable disease
after the introduction of multidrug therapy with dapsone, rifampicin and clofazimine in
early 1980s . Nowadays patients are treated and managed at out patients clinics while
they are engaging their routine work at home and work places.
Mycobacterium leprae , the causative organism of leprosy was the first pathogenic
bacterium , discovered in the medical history. This bacteria can disseminate in air as a
droplet infection through sneezing or coughing of a patient who are in the infective stage.
Mycobacterium leprae can enter to the human body through upper respiratory tract or
abraded skin. It should be remembered that eight out of ten leprosy patients are not
infectious. Even this small proportion of infectious patients become non infectious after
commencing treatment. Other distinctive factor is the possessing of inherent immunity
to this bacteria by 90 to 95% of normal population. Therefore it is not a cause for fear
psychosis among the people today.
Everyone should have basic knowledge on early signs or manifestations of this curable
disease to allow the commencement of treatment at correct time to avoid any
complications. These signs are pale or reddish skin patches with loss of sensation, skin
nodules and lumps, painless wounds in hands and feet, neurological deformities and
ocular manifestations such as inability to close the eyes.
According to WHO reports, the global prevalence of leprosy at the beginning of 2009
was at 213036 cases, while the number of new cases detected during 2008 was 249007.
The number of new cases detected globally has fallen by 4% during 2008 compared
with 2007. Pockets of high endemicity still remain in some areas of India, Nepal,
Tanzania, Congo, Brazil, Angola, Central Africa, Madagascar and Mozambique.

3. Sri Lanka has reached the target of elimination of leprosy as a public health problem
with the prevalence of less than one patient for 10,000 population at national level in
1995. Even though the prevalence as a country is low, nearly 2000 new patients are
diagnosing in a year up to now. The very unfortunate incidence is that some of these new
patients are with late complications of the disease at the time of diagnosis, due to delay in
seeking treatment.
Advices from the dermatology and out patients clinics at the government hospitals is
essential in suspicion of an early sign of the disease. Leprosy can be completely cured
with drugs that are widely available and free of charge. It is a responsibility of everyone
to have a basic knowledge on this curable disease to increase the rate of self referral and
positive attitude of society towards persons with leprosy.
Dr. SHANTHA HETTIARACHCHI